Spinal Infection

Overview

Spinal infections involve the:

• Intervertebral disc space
• Spinal canal
• Surrounding soft tissue
• Vertebral column

The infections, bacteria or fungal can present 3 days to 3 months after surgery.

Intervertebral disc space infections are between two vertebrae. Disc space infections are classified into 3 subcategories:

• Discitis (childhood)
• Postoperative
• Spontaneous (adult hematogenous or blood-borne)

Vertebral Osteomyelitis is the most common type of spinal infection, which can happen from trauma creating open access to the spinal area, from bacteria located traveling to the vertebra from blood, or from an infection in the surrounding tissues.

Epidural abscesses are rare and mostly seen in people over age 50.

Risk factors include:

• Cancer
• Chronic steroid use
• Diabetes mellitus
• Human immunodeficiency virus (HIV)
• IV drug use
• Malnutrition
• Older age
• Organ transplantation

Surgical risk factors include:

• High blood loss
• Instrumentation implants

Symptoms

Symptoms vary depending on location and cause of the spinal infection but one can experience the following:

• Redness, swelling, tenderness near an incision site
• Wound drainage
• Fever
• Chills
• Weight loss
• Severe back pain
• Muscle spasms
• Weakness
• Numbness of arms or legs
• Loss of bowel or bladder function
• Painful urination

If one feels weakness of arms or legs, incontinence or uncontrolled fever, seek medical attention immediately.

Causes of Spinal Infections

Bacteria (mostly staphylococcus aureaus and Escherichia coli) can travel to the spine through the blood stream.  Fungus from another part of the body can travel the same way.

Dental procedures can increase the risk of spinal infections since bacteria can be introduced into the bloodstream. IV drug abusers are more susceptible to cervical infections and spinal infections can happen after a urological procedure since the veins in the lower spine arise through the pelvis.

It is unclear how spinal infections occur in children and there is a theory that it is caused by partial dislocation of the growth area by the end of the bone (epiphysis) in a flexion injury.

Short-Term Treatment of Spinal Infections

While nonsurgical treatment should be thought of first, surgery is indicated if there is:

• Failure of IV antibiotics to eradicate the infection
• Inability to obtain cultures
• Neurological deficits
• Sepsis with toxicity from an abscess not responding to antibiotics

The purpose of the surgery is to:

• Clean and removed infected tissue (debride)
• Improve blood flow to infected tissue to enable better healing
• Restore function or limit neurological impairment
• Restore spinal stability

Long Term Treatment of Spinal Infections

Long-term intravenous antibiotic or antifungal therapy may be needed, necessitating a long hospitalization term, after the cause is cultured and identified.  This therapy takes at least 6-8 weeks. The actual antibiotic protocol depends on the organisms and the patient’s age.

Immobilization may be advised for pain or spinal instability.

Alternative Therapies for Spinal Infection

A chiropractor can increase joint mobility and improve nervous system and spinal health through manipulation.  Adjustments improve coordination, provide relief from discomfort and pain, and hasten the healing of the infectious process.

Chiropractors work together with the other members of the doctor team to insure that the patient gets optimal treatment.

High-velocity manipulation is contraindicated with osteomyelitis (spinal bone infection) however.

Acupuncture may help during an immobilization process done for pain.

 

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Resources

Carnes D, Mars TS, Mullinger B, et al. Adverse events and manual therapy: A systematic review. Man Ther. 2010; 15:355-363.

www.spinehealthlife.com/conditions/spinal-infections/